DOI: https://doi.org/10.36347/sjmcr.2026.v14i04.045

Pages: 777-780

Genitourinary tuberculosis (GUTB) remains a diagnostic challenge because clinical manifestations are often non‑specific, bacilluria may be intermittent, and imaging findings can mimic malignancy or other inflammatory causes of ureteral obstruction. We report an atypical presentation of GUTB as an isolated distal ureteral stenosis revealed by persistent renal colic. A 66‑year‑old man presented with a two‑month history of right-sided renal colic without lower urinary tract symptoms or fever. Computed tomography urography showed right hydronephrosis with circumferential thickening of the renal pelvis and ureter, upstream of a short distal ureteral stricture. Cystoscopy revealed a punctiform right ureteric orifice requiring endoscopic enlargement to permit placement of a double‑J stent. Ureteroscopic biopsies demonstrated granulomatous inflammation with caseous necrosis, supporting the diagnosis of urogenital tuberculosis. Mycobacterial urine culture and chest imaging did not show concomitant pulmonary disease. The patient completed a six‑month antituberculous regimen with a favorable clinical outcome. This case highlights the importance of considering GUTB in patients with unexplained ureteral strictures, particularly when routine urine cultures are negative, to avoid diagnostic delay and irreversible urological sequelae.